• Journal of the Korean association of regional geographers
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• v.3 no.2
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• pp.163-193
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• 1997

Medical services are a fundamental and essential service in all urban areas. The location and accessibility of medical service facilities and institutions are critical to the diagnosis, control and prevention of illness and disease. The purpose of this paper is to present the results of a study on the location of medical facilities in Kwangju and the utilization of these facilities by the inhabitants. The following information is a summary of the findings: (1) Korea, like many countries, is now witnessing an increase in the age of its population as a result of higher living standards and better medical services. Korea is also experiencing a rapid increase in health care costs. To ensure easy access to medical consultation, diagnosis and treatment by individuals, the hierarchical efficient location of medical facilities, low medical costs, equalized medical services, preventive medical care is important. (2) In Korea, the quality of medical services has improved significantly as evident by the increased number of medical facilities and medical personnel. However, there is still a need for not only quantitative improvements but also for a more equitable distribution of and location of medical services. (3) There are 503 medical facilities in Kwangju each with a need to service 2,556 people. This is below the national average of 1,498 inhabitants per facility. The higher locational quotient and satisfactory population per medical facility showed at the civic center. On the other hand, problem regions such as the traditional residential area in Buk-Gu, Moo-deung mountain area and the outer areas of west Kwangju still maintain rural characteristics. (4) In the study area there are 86 general medicine clinics which provide basic medical services. i. e. one clinic per every 14,949 residents. As a basic service, its higher locational quotient showed in the residential area. The lower population concentration per clinic was found in the civic center and in the former town center, Songjeong-dong. In recently build residential areas and in the civic center, the lack of general medicine clinics is not a serious medical services issue because of the surplus of medical specialists in Korea. People are inclined to seek a consultation with a specialist in specific fields rather than consult a general practitioner. As a result of this phenomenon, there are 81 internal medicine facilities. Of these, 32.1% provide services to people who are not referred by a primary care physician but who self-diagnose then choose a medical facility specializing in what they believe to be their health problem. Areas in the city, called dongs, without any internal facilities make up 50% of the total 101 dongs. (5) There are 78 surgical facilities within the area, and there is little difference at the locational appearance from internal medicine facilities. There are also 71 pediatric health clinics for people under 15 years of age in this area, represents one clinic per 5,063 people. On the quantitative aspect, this is a positive situation. Accessibility is the most important facility choice factor, so it should be evenly located in proportion to demander distribution. However, 61% of 102 dongs have no pediatric clinics because of the uneven location. (6) There are 43 obstetrical and gynecological clinics in Kwangju, and the number of residents being served per clinic is 15,063. These services need to be given regularly so it should increase the numbers. There are 37 ENT clinics in the study area with the lower concentration in Dong-gu (32.4%) making no locational differences by dong. There are 23 dermatology clinics with the largest concentration in Dong-Gu. There are 17 ophthalmic clinics concentrated in the residential area because of the primary function of this type of specialization. (7) The use of general medicine clinics, internal medicine clinics, pediatric clinics, ENT clinics by the inhabitants indicate a trend toward primary or routine medical services. Obstetrics and gynecology clinics are used on a regular basis. In choosing a general medicine clinic, internal medicine clinic, pediatric clinic, and a ENT clinic, accessibility is the key factor while choice of a general hospital, surgery clinic, or an obstetrics and gynecology clinic, thes faith and trust in the medical practitioner is the priority consideration. (8) I considered the efficient use of medical facilities in the aspect of locational and management and suggest the following: First, primary care facilities should be evenly distributed in every area. In Kwangju, the number of medical facilities is the lowest among the six largest cities in Korea. Moreover, they are concentrated in Dong-gu and in newly developed areas. The desired number of medical facilities should be within 30 minutes of each person's home. For regional development there is a need to develop a plan to balance, for example, taxes and funds supporting personnel, equipment and facilities. Secondly, medical services should be co-ordinated to ensure consistent, appropriate, quality services. Primary medical facilities should take charge of out-patient activities, and every effort should be made to standardize and equalize equipment and facility resources and to ensure ongoing development and training in the primary services field. A few specialty medical facilities and general hospitals should establish a priority service for incurable and terminally ill patients. (9) The management scheme for the inhabitants' efficient use of medical service is as follows: The first task is to efficiently manage medical facilities and related services. Higher quality of medical services can be accomplished within the rapidly changing medical environment. A network of social, administrative and medical organizations within an area should be established to promote information gathering and sharing strategies to better assist the community. Statistics and trends on the rate or occurrence of diseases, births, deaths, medical and environment conditions of the poor or estranged people should be maintained and monitored. The second task is to increase resources in the area of disease prevention and health promotion. Currently the focus is on the treatment and care of individuals with illness or disease. A strong emphasis should also be placed on promoting prevention of illness and injury within the community through not only public health offices but also via medical service facilities. Home medical care should be established and medical testing centers should be located as an ordinary service level. Also, reduced medical costs for the physically handicapped, cardiac patients, and mentally ill or handicapped patients should be considered.

• Journal of the Korean association of regional geographers
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• v.3 no.2
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• pp.37-87
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• 1997

As a results of researches on the cultivation processes and settlement developments on the Mangyoung river valley as a whole could be have four 'Space-Time Continuity' through a [Origin-Destination] theory model. On a initial phases of cultivation, the cultivation process has been begun at mountain slopes and tributory plains in upper part of river-basin from Koryo Dynasty to early Chosun Dynasty. At first, indigenous peasants burned forests on the mountain slopes for making 'dryfield' for a cereal crops. Following population increase more stable food supply is necessary facets of life inducing a change production method into a 'wetfield' in tributory plains matching the population increase. First sedentary agriculture maybe initiated at this mountain slopes and tributory plains on upper part of river basin through a burning cultivation methods. Mountain slopes and tributory plains are become a Origin area in cultivation processes. It expanded from up to down through the valleys with 'a bits of land' fashion in a steady pace like a terraced fields expanded with bit by bit of land to downward. They expanded their land to the middle part of river basin in mid period of Chosun Dynasty with dike construction techniques on the river bank. Lower part of river cultivated with embankment building techniques in 1920s and then naturally expanded to the tidal marshes on the estuaries and river inlets of coastal areas. 'Pioneer fringes' are consolidated at there in modern times. Changes in landscapes are appeared it's own characters with each periods of time. Followings are results of study through the Mangyoung river valley as a whole. (1) Mountain slopes and tributory plains on the upper part of river are cultivated 'dryfields' by indigenous peasants with Burning cultivation methods at first and developed sedentary settlements at the edges of mountain slopes and on the river terrace near the fields. They formed a kind of 'periphery-located cluster type' of settlement. This type of settlement are become a prominant type in upper part of river basin. 'Dryfields' has been changed into a 'wetfields' at the narrow tributory plains by increasing population pressure in later time. These wetfields are supplied water by Weir and Ponds Irrigation System(제언수리방법). Streams on the tributory plains has been attracted wetfields besides of it and formed a [water+land] complex on it. 'Wetfields' are expanded from up to downward with a terraced land pattern(adder like pattern, 붕전) according to the gradient of valley. These periphery located settlements are formed a intimate ecological linkage with several sets of surroundings. Inner villages are expanded to Outer villages according to the expansion of arable lands into downward. (2) Mountain slopes and tributory plains expanded its territory to the alluvial deposited plains on the middle part of river valley with a urgent need of new land by population increase. This part of alluvial plains are cultivated mainly in mid period of Chosun Dynasty. Irrigation methods are changed into a Dike Construction Irrigation method(천방수리방법) for the control of floods. It has a trend to change the subjectives of cultivation from community-oriented one who constructed Bochang along tributories making rice paddies to local government authorities who could be gather large sums of capitals, techniques and labours for the big dike construction affairs. Settlements are advanced in the midst of plains avoiding friction of distances and formed a 'Centrallocated cluster type' of settlements. There occured a hierarchical structures of settlements in ranks and sizes according merits of water supply and transportation convenience at the broad plains. Big towns are developed at there. It strengthened a more prominant [water+land] complex along the canals. Ecological linkages between settlements and surroundings are shaded out into a tiny one in this area. (3) It is very necessary to get a modern technology of flood control at the rivers that have a large volume of water and broad width. The alluvial plains are remained in a wilderness phase until a technical level reached a large artificial levee construction ability that could protect the arable land from flood. Until that time on most of alluvial land at the lower part of river are remained a wilderness of overgrown with reeds in lacks of techniques to build a large-scale artificial levee along the riverbank. Cultivation processes are progressed in a large scale one by Japanese agricultural companies with [River Rennovation Project] of central government in 1920s. Large scale artificial levees are constructed along the riverbank. Subjectives of cultivation are changed from Korean peasants to Japanese agricultural companies and Korean peasants fell down as a tenant in a colonial situation of that time in Korea. They could not have any voices in planning of spatial structure and decreased their role in planning. Newly cultivated lands are reflected company's intensions, objectives and perspectives for achieving their goals for the sake of colonial power. Newly cultivated lands are planned into a regular Rectangular Block settings of rice paddies and implanted a large scale Bureaucratic-oriented Irrigation System on the cultivated plains. Every settlements are located in the midst of rice paddies with a Central located Cluster type of settlements. [water+land] complex along the canal system are more strengthened. Cultivated space has a characters of [I-IT] landscapes. (4) Artificial levees are connected into a coastal emnankment for a reclamation of broad tidal marshes on the estuaries and inlets of rivers in the colonial times. Subjectives of reclamation are enlarged into a big agricultural companies that could be acted a role as a big cultivator. After that time on most of reclamation project of tidal marshes are controlled by these agricultural companies formed by mostly Japanese capitalists. Reclaimed lands on the estuaries and river inlets are under hands of agricultural companies and all the spatial structures are formed by their intensions, objectives and perspectives. They constructed a Unit Farming Area for the sake of companies. Spatial structures are planned in a regular one with broad arable land for the rice production of rectangular blocks, regular canal systems and tank reservoir for the irrigation water supply into reclaimed lands. There developed a 'Central-located linear type' of settlements in midst of reclaimed land. These settlements are settled in a detail program upon this newly reclaimed land at once with a master plan and they have planned patterns in their distribution, building materials, location, and form. Ecological linkage between Newly settled settlemrnts and its surroundings are lost its colours and became a more artificial one by human-centred environment. [I-IT] landscapes are become more prominant. This region is a destination area of [Origin-Destination] theory model and formed a 'Pioneer Fringe'. It is a kind of pioneer front that could advance or retreat discontinously by physical conditions and socio-cultural conditions of that region.